Bulent Oktay

Role of ejaculation in the treatment of chronic non-bacterial prostatitis

Background: Chronic non‐bacterial prostatitis (NBP) is the most common prostatitis syndrome. Prevention and cure are not possible because the cause of NBP is unknown. However, patients may benefit from supportive measures. The impact of the frequency of ejaculation alone on the course of NBP was evaluated in the present study.

Angiotensin-II receptor antagonist losartan reduces microalbuminuria in hypertensive renal transplant recipients

In recent years, it has been demonstrated that losartan lowers macroproteinuria in diabetic or non‐diabetic renal transplant recipients (RTx) similar to angiotensin converting enzyme (ACE) inhibitors. Microalbuminuria (MAU) may reflect subclinical hyperfiltration damage of the glomerulus. It could be a marker of kidney dysfunction in renal transplantation. The aim of the study was to assess the efficacy of losartan in hypertensive RTx with MAU. This study was conducted in 17 (M/F: 4/13) stable RTx. No change was made in the medical treatment of the patients. All cases received 50 mg/day losartan therapy for 12 wk. Renal functions and MAU were determined 12 and 6 wk and just before the treatment as well as sixth and twelfth week of the treatment in all patients. Losartan satisfactorily lowered systemic blood pressure. A significant reduction in MAU was observed from 103 ± 53 μg/min at the beginning to 59 ± 25 μg/min in the sixth week and 47 ± 24 μg/min in the twelfth week (p=0.0007 and 0.0005, respectively). From the sixth week of the treatment, the therapy significantly decreased hemoglobin, hematocrit and erythrocyte levels but did not change mean leukocyte and platelet counts, urea, creatinine levels and creatinine clearances. No serious side‐effect was observed during the study.

Treatment of Retrocaval Ureter by Pure Laparoscopic Pyelopyelostomy: Experience on 4 Patients

OBJECTIVES To present our experience and the feasibility of pure laparoscopic pyelopyelostomy for treatment of retrocaval ureter (RCU). METHODS RCU was detected in 4 male (ages: 4, 16, 36, 48) patients, with complaints of flank pain. In all the patients, Type 1 RCU was present and the right ureter was involved. All patients underwent intraoperative retrograde pyelography before laparoscopy. The patients were operated upon using the transperitoneal approach in the lateral decubitis position, with two 10 mm and two 5 mm ports. After the ureter was released from the superior and inferior parts of the inferior vena cava, the dilated renal pelvis was transected and the ureter was brought in an anterolateral position to the vena cava. After the completion of the posterior wall anastomosis of pyelopyelostomy with 4-0 polyglactin sutures in a continuous manner, a double-J-stent was placed and the anterior wall was anastomosed in a watertight manner. A drain was placed in the operative area and the operation was completed. RESULTS Mean operation time was 210 minutes. No intraoperative complications occurred. In one patient, antegrade double-J-stent placement failed, and the stent was therefore placed in the retrograde way without any complications. Postsurgery, the urethral catheter was removed on the first day, and the drain on the second. All patients were discharged 48 hours after surgery. The third month postoperative follow-up confirmed that the anastomoses were patent and patients were symptom-free. CONCLUSIONS Pure laparoscopic pyelopyelostomy seems technically feasible and reliable for RCU treatment. Our experience showed that laparoscopy should be the standard treatment option for such patients.

The effects of ejaculation on serum prostate-specific antigen (PSA)

To determine the effects of ejaculation on serum PSA, we measured serum levels just before masturbation and 24 hours and 5 days later in a study group (n=25) aged between 23 and 25 years. In the study group, 16 cases showed a decrease (mean 22.37%, range 10–50%) in serum PSA levels 24 hours after ejaculation, while 6 had higher levels (mean 38.33%, range 21–67%) and 3 had no changes. No relation was found between seminal plasma levels or total amounts expelled of this marker and the difference in serum levels due to ejaculation. In the control group free of ejaculation in the same period determinations of serum PSA levels revealed no significant changes between days 0, 1 and 5.As compared with the control group, the changes in the study group were found to be statistically insignificant. These results may indicate that ejaculation has an insignificant effect on serum PSA levels.

RENAL CELL CARCINOMA WITH SOLITARY SYNCHRONOUS PANCREATICODUODENAL AND METACHRONOUS PERIPROSTATIC METASTASES : REPORT OF A CASE

We report herein the case of a patient who underwent successful resection of a solitary metachronous periprostatic metastasis 12 months after undergoing a right radical nephrectomy with pylorus-preserving pancreatico-duodenectomy for renal cell carcinoma (RCC) with a synchronous pancreaticoduodenal metastasis. At present the patient is free of any signs of recurrence 12 months after removal of the metachronous mass in the periprostate. This case report supports the opinion that an aggressive surgical approach is appropriate for RCC metastasis.

Percutaneous Suprapubic Transvesical Route: A New and Comfortable Method of Intraprostatic Injection

To assess the efficacy and safety of the percutaneous suprapubic transvesical route (STR) for intraprostatic antibiotic injections and compare it with the transperineal route (TPR), a total of 37 patients suffering from chronic bacterial prostatitis, resistant even to treatment with fluoroquinolones, were randomized to intraprostatic amikacin injections using either STR (n = 19) or TPR (n = 18). Follow-ups were done at weeks 4, 12, 24 and 52. Patients found to have failures at the first follow-up were given an additional injection using the initial route. At the 24th week, 15 patients from both groups were given another injection using the alternative route and were asked to report any subsequent voiding difficulties and compare the discomfort and pain experienced. At the end of 52 weeks, bacteriological cure rates did not differ significantly (44.4 vs. 47.3%). Overall improvement rates in the severity of symptoms and signs were similiar. Considerable difficulty in directing the needle to the prostate due to an excessive amount of subcutaneous fat was experienced, and more than 1 skin puncture was necessary in 5 of the STR group, whereas in the TPR group 7 patients with external hemorrhoids and 1 patient with a rectal fissure had prominent discomfort and pain during the transperineal procedures. Complications such as dysuria or hemospermia were encountered infrequently in both groups, but hematuria was observed more frequently in the STR group (85 vs. 54%). Less discomfort (p < 0.01) and pain (p < 0.01) were reported during access to the prostate by STR, but pain during the injection of the drug did not differ significantly. In conclusion, the percutaneous STR may well be used efficiently and comfortably as an alternative method to TPR when intraprostatic injections are needed in a limited number of cases such as those with a known hypersensitivity to fluoroquinolones or with a history of failure despite long-term systemic treatment with these agents.

Prevalence of Transfusion Transmitted Virus Infection and its Effect on Renal Graft Survival in Renal Transplant Recipients

Objective : Little is known about the prevalence of transfusion transmitted virus (TTV) infection in renal transplant recipients (RTxs) and its effects on allograft survival. We investigated the prevalence of TTV and its effects on liver injury and graft survival in RTxs. Material and Methods : The study was performed in 33 consecutive RTxs (8 females, 25 males) and 100 blood donors (35 females, 65 males). A nested polymerase chain reaction was used to detect TTV DNA in serum. Serum creatinine and alanine aminotransferase (ALT) levels and 24-h protein excretion were determined in both TTV-positive and -negative patients. The total number of blood transfusions, the duration of hemodialysis and the total duration after transplantation were recorded in RTxs. In addition, hepatitis B surface antigen (HbsAg), anti-hepatitis C virus (HCV) and hepatitis G virus DNA antibodies were determined in all patients. Results : TTV DNA was detected in 51.5% of RTxs and in 7% of the control group and this difference was statistically significant ( p < 0.01). In the RTx group, 64.7% of TTV-positive and 56.2% of TTV-negative patients had undergone a previous blood transfusion. However, the blood transfusion replacement rate, total duration of dialysis therapy and posttransplant period did not differ between these two groups. Five (15.1%) patients in the RTx group had abnormal liver function tests (ALT >40 IU/l). Of these patients, 2 were anti-HCV-positive, 1 was HBsAg-positive and anti-HCV- plus TTV DNA-positive and the serologic tests of the remaining 2 patients were all negative. Among the TTV-positive patients, 2 (11.7%) were anti-HCV-positive, 1 (5.8%) was HBsAg-positive and 3 (17.6%) were HGV DNA-positive. The baseline serum creatinine levels did not differ significantly between the TTV-positive and -negative patients, being 1.5 - 0.6 and 1.4 - 0.6 mg/dl, respectively (p > 0.05). Two of the TTV-positive patients and 1 of the TTV-negative patients had proteinuria. A 1-year follow-up of TTV-positive and -negative patients demonstrated neither acute nor chronic graft rejection. Conclusion : In RTxs, TTV infection was more prevalent than in the normal population. In our patients the virus did not have an important effect on renal graft rejection and did not cause liver injury. However, the question of whether TTV infection may affect graft survival requires further long-term investigation in larger groups.

Intracorporeal Pneumatic Lithotripsy for Ureteral and Vesical Calculi

To evaluate the effectiveness of pneumatic lithotripsy, 92 patients with 98 lower or mid-ureteric calculi and 8 with vesical calculi were treated with pneumatic lithotripsy (Swiss Lithoclast) under spinal anaesthesia. Successful stone fragmentation was achieved in 96 patients. In two patients their stones migrated to the upper ureter and renal pelvis during the procedure and so they were referred for extra corporeal shock wave lithotripsy. Total ureteral avulsion occurred in one patient and in another case attempts to dilate the stenotic ureteral orifice failed. In both cases, ureterolithotomy and ureteral reimplantation were performed. Pneumatic lithotripsy is found to be an easy, reliable and cost-effective method of endoscopic lithotripsy.

Single-Port Extraperitoneal Transvesical Adenomectomy: Initial Operative Experience

Background: Laparoscopic extraperitoneal adenomectomy is occasionally performed for symptomatic large-volume benign prostatic hyperplasia. Two different multichannel ports were used during operations. We describe the technique of single-port extraperitoneal transvesical adenomectomy and present the initial operative experience. Methods: Three patients in whom an open adenomectomy was indicated underwent single-port extraperitoneal transvesical adenomectomy. Following preparation of the extraperitoneal space via an umbilical incision, a multichannel port was inserted. A transverse cystotomy adjacent to the prostatovesical junction, incision of mucosa overlying the adenoma, subcapsular plane development, prostatic adenomectomy and cystotomy repair were performed as the standard steps of the laparoscopic procedure. Results: All cases were completed without conversion to standard laparoscopy. Mean operative time was 105 min. Mean blood loss was 190 ml. Hospital stay was 4 days and catheter duration was 6 days for all patients. No intraoperative or postoperative complication occurred. Conclusions: Single-port extraperitoneal transvesical adenomectomy for large benign prostate hyperplasia is feasible with excellent cosmetic results and minimal morbidity.

Pneumatic Lithotriptor - A Useful Tool for Challenging Renal Stone Surgery

Open surgical measures may be undertaken in the treatment of some complex calculi and manoeuvres such as extended pyelolithotomy or nephrolithotomy may be necessary. In an attempt to improve surgical results with less morbidity and maximum ease, we used the Swiss Lithoclast to disintegrate large stones presenting as hard cases.Five patients with renal pelvic stones associated with calyceal stones in two and two further cases with staghorn stones were treated surgically using the pneumatic lithotriptor probe with less dissection and without nephrotomy. Only one of the patients with staghorn stones had residual fragments which were then treated with ESWL.We believe that when open surgical treatment is considered in hard cases, especially in those with small renal pelvises, the best results may be achieved with minimum surgical intervention if it is combined with pneumatic lithotripsy.